Project Summary Sudden death resulting from cardiac arrhythmias is the most common consequence of cardiac disease and is oftena result of abnormal impulse formation. Such triggered activity are associated with abnormal Ca2+ release from the sarcoplasmic reticulum (SR) and are a hallmark of catecholaminergic polymorphic ventricular tachycardia (CPVT). CPVT-associated mutations in the ryanodine receptors (RyR2) or calsequestrin (Casq2), the major intra-SR Ca2+ binding protein render the RyR2 leaky and predispose these patients to arrhythmias. Atrial fibrillation is an another common finding in CPVT, indicating that Ca2+ mishandling in CPVT is not isolated to the ventricles. Despite high response of CPVT to Ca2+ channel- and/or beta-blockers, refractory cases often require Na+ channel inhibitor based therapy. However, the relationship between Na+ influx and disturbances in Ca2+ handling immediately preceding arrhythmias in CPVT remains poorly understood. The applicant has developed an experimental system using various murine models of CPVT that integrates information of Ca2+ handling at the cellular level with the electrophysiologic phenotype in tissue. The applicant plans to investigate the hypothesis that subpopulation of Na+ channels (neuronal Na+ channels; nNav) contribute to arrhythmogenic aberrant Ca2+ release through the microdomain Na+/Ca2+ signaling. Specifically the proposal will address the following aims during the mentored phase (K99): 1) Elucidate the molecular and subcellular consequences of subdomain-specific Na+/Ca2+ signaling on aberrant Ca2+ release in the genesis of Ca2+ -dependent atrial and ventricular arrhythmias. Here we will test the hypothesis that subdomain-specific Na+/Ca2+ signaling contributes to arrhythmogenic aberrant Ca2+ release while attempting to identify the molecular determinants of local Na+/Ca2+ subdomain signaling. 2) Define the role of Na+/Ca2+ signaling in tissue wide aberrant Ca2+ release synchronization. These translational studies will test the hypothesis that subdomain-specific Na+/Ca2+ signaling facilitates myocardial synchronization of aberrant Ca2+ release and promotes subsequent ectopic activity in intact ventricular tissue. 3) Validate the applicability of Na+/Ca2+ signaling to in vivo settings. During the independent phase (R00) the proposal will: 1) Investigate the role of subdomain-specific Na+/Ca2+ signaling on aberrant Ca2+ release in the genesis of atrial arrhythmias. 2) Examine the regional heterogeneities of the subdomain-specific Na+/Ca2+ signaling in atrial aberrant Ca2+ release synchronization. 3) Validate the therapeutic potential of perturbation of Na+/Ca2+ signaling in settings of atrial arrhythmias and translate the applicability to animal models of acquired Ca2+-mediated arrhythmias. The mechanistic and pharmacological insights gained on the cellular as well as on tissue levels will offer a mechanism-based therapeutic approach that will be tested in vivo. Furthermore, these studies will determine whether such arrhythmogenic mechanism(s) is/are applicable to a clinically-relevant model of Ca2+-mediated arrhythmias. A long term goal of this study is to better understand the cellular and molecular mechanisms of Ca2+-mediated arrhythmogenesis.